Autonomic thermoregulatory dysfunction in neurofibromatosis type 1 / Disfunção autonômica termorregulatória na neurofibromatose do tipo 1

ABSTRACT Objective Neurofibromatosis type 1 (NF1) causes neural and cutaneous disorders and reduced exercise capacity. Exercise/heat exposure increasing internal temperature must be compensated by eccrine sweat function and warmed skin vasodilation. We suspected NF1 could adversely affect eccrine sweat function and/or vascular thermoregulatory responses (VTR). Methods The eccrine sweat function and VTR of 25 NF1 volunteers (14 males, 11 females; 16–57 years old) were compared with 23 non-NF1 controls matched by sex, age, height and weight (CG). Sweating was induced by 1) pilocarpine 1% iontophoresis (PILO); and 2) by passive heating (HEAT) via the lower third of the legs being immersed in 42°C water for one hour. Previously established eccrine sweat function and VTR protocols were used. Results The NF1 group showed: a) lower sweat rate than the CG group during PILO; b) a smaller diastolic pressure decrease; and c) higher tympanic temperatures than controls during HEAT (p < 0.05). Conclusion Reduced sweating and vascular thermoregulatory responses suggest autonomic dysfunction in NF1 individuals.

RESUMO Objetivo Neurofibromatose do tipo 1 (NF1) causa problemas neurais e cutâneos e diminuição da capacidade física. O aumento da temperatura interna durante exercício e exposição ao calor precisa ser compensada pela função sudorípara écrina (FSE) e aquecimento cutâneo por vasodilatação (RVT). Suspeitou-se clinicamente que a NF1 poderia prejudicar a FSE e a RVT. Métodos A FSE e RVT de 25 voluntários com NF1 (14 homens, 11 mulheres; 16–57 anos) e de 23 sem-NF1, emparelhados por sexo, idade, estatura e peso corporal, foram medidas com protocolos validados anteriormente. A sudorese foi induzida por iontoforese com pilocarpina (PILO) e aquecimento passivo por imersão das pernas em água a 42°C durante uma hora (HEAT). Resultados O grupo NF1 apresentou menor taxa de sudorese na situação PILO, menor redução da pressão diastólica e maior temperatura timpânica na situação HEAT (p < 0.05). Conclusão As respostas sudorípara e vascular reduzidas sugerem disfunção autonômica nas pessoas com NF1.

Avaliação quantitativa da intensidade da transpiração palmar e plantar em pacientes portadores de hiperidrose palmoplantar primária / Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis

OBJETIVO: Comparar a intensidade de transpiração em palmas das mãos e planta dos pés de indivíduos portadores de hiperidrose com a de um grupo controle. MÉTODOS: Foram selecionados 50 pacientes com diagnóstico clínico de hiperidrose palmoplantar e 25 indivíduos controles. Um método objetivo de quantificação da transpiração foi utilizado com um aparelho eletrônico portátil, não invasivo, com sensores de umidade relativa e de temperatura capazes de quantificar a perda de água transepidérmica. Todos os indivíduos apresentavam índice de massa corpórea de 20-25 kg/cm² e permaneceram em repouso por 20-30 min antes das medições para reduzir a interferência externa. A mensuração foi realizada em sala climatizada com a temperatura de 21-24ºC. Os locais determinados para a aferição foram região hipotenar da face palmar e região medial da face plantar. RESULTADOS: No grupo com hiperidrose palmoplantar, as médias da intensidade de transpiração nas mãos e nos pés foram de, respectivamente, 133,6 ± 51,0 g/m²/h e 71,8 ± 40,3 g/m²/h, enquanto, no grupo controle, essas foram de 37,9 ±18,4 g/m²/h e 27,6 ± 14,3 g /m²/h. As diferenças das médias entre os grupos foram estatisticamente significativas (p < 0,001). CONCLUSÕES: Este método de quantificação mostrou-se uma ferramenta precisa e confiável na avaliação da transpiração palmar e plantar, quando operado por um profissional treinado e capacitado.

OBJECTIVE: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. METHODS: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm². Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24ºC). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. RESULTS: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 ± 51.0 g/m²/h and 71.8 ± 40.3 g/m²/h, respectively, compared with 37.9 ± 18.4 g/m²/h and 27.6 ± 14.3 g/m²/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). CONCLUSIONS: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.

Proposição de método simples e barato para o estudo dinâmico da sudorese na pele restaurada pós-queimaduras de segundo grau / Proposal of simple and inexpensive method for the dynamic study of sweating in skin restored after second-degree burns

Introdução: Um sistema integrado para estimular a sudorese e avaliá-la dinâmica e continuadamente com o uso de gravação digital é descrito nesse artigo. Método: Consiste de um pequeno aparelho portátil para estimular a sudorese, funcionando a bateria de 9 volts. As gotas de suor produzidas são monitoradas e podem ser sequencialmente fotografadas ou continuadamente gravadas em vídeo digital por câmera posicionada a certa distância da pele. As imagens são então analisadas por um programa de computador capaz de contar as gotas em momentos específicos, podendo-se acompanhar o desenvolvimento delas até sua confluência. Conclusão: O pequeno tamanho e peso do equipamento fazem-no facilmente transportável. É possível, assim, a gravação continuada e análise dinâmica da sudorese, utilizando um método nacional, simples, barato e pouco trabalhoso.

Introduction: An integrated system to stimulate sweating and evaluate it through dynamic and continuous digital recording is described in this article. Methods: It consists of a small portable device to stimulate sweating, running a 9-volt battery. The drops of sweat produced are monitored and can be photographed sequentially or continuously recorded on digital video by camera positioned at some distance from the skin. The images are then analyzed by software able of countingthe drops at specific time, being able to monitor their development to its confluence. Conclusion: The small size and weight make it easily transportable. It is thus possible to record continuous and dynamic analysis of sweating, using a national method, simple, cheap and not very laborious.

Estudo de pacientes com hiperidrose, tratados com toxina botulínica: análise retrospectiva de 10 anos / Study of patients with hyperhidrosis treated with botulinum toxin: a 10-year retrospective analysis

INTRODUÇÃO: A hiperidrose caracteriza-se por sudorese excessiva, isolada ou associada, da testa, das mãos, dos pés e das axilas. Atinge cerca de 1 por cento da população. O objetivo deste estudo foi observar os efeitos da toxina botulínica nos pacientes com hiperidrose, demonstrando a técnica, as áreas de incidência e a duração dos resultados obtidos. MÉTODO: Foi realizada análise retrospectiva de 39 pacientes com hiperidrose primária tratados no período de julho de 2000 a julho de 2010, acompanhados durante 12 meses. Desses pacientes, 36 por cento eram do sexo masculino e 64 por cento, do sexo feminino. A idade variou de 16 anos a 41 anos. No total, foram tratadas 135 áreas. Realizou-se tratamento com injeções intradérmicas de toxina botulínica. A dose total aplicada variou entre 37,5 U e 150 U, com dose média de 75 U para cada região tratada. RESULTADOS: O efeito terapêutico foi observado a partir do terceiro dia, com redução de 50 por cento dos sintomas na primeira semana do tratamento e de até 94 por cento do quadro de hiperidrose após a segunda semana de tratamento. A redução dos sintomas durou, em média, 7 meses. Nenhum caso de hiperidrose compensatória foi observado. A mortalidade foi nula. CONCLUSÕES: O tratamento da hiperidrose primária com toxina botulínica tipo A, embora temporário, é uma opção de tratamento eficaz, segura, pouco invasiva e com alto grau de satisfação, permitindo aos doentes o retorno às atividades profissionais no mesmo dia. Os efeitos colaterais e as complicações são temporários, pouco frequentes e regridem sem deixar sequelas.

BACKGROUND: Hyperhidrosis is characterized by excessive sweating of the forehead, hands, feet, and armpits, either alone or in combination. It affects about 1 percent of the population. This study aimed to observe the effects of botulinum toxin in patients with hyperhidrosis and demonstrates the application technique of botulinum toxin, the areas of incidence of the disease, and the duration of the results. METHODS: A retrospective analysis of 39 patients with primary hyperhidrosis treated between July 2000 and July 2010 and followed up for 12 months was carried out. Of these patients, 36 percent were male and 64 percent were female. Patient ages ranged from 16 to 41 years. A total of 135 areas were treated. Treatment consisted of intradermal injections of botulinum toxin. The total dose applied ranged from 37.5 U to 150 U, with an average dose of 75 U for each treated area. RESULTS: The therapeutic effect of botulinum toxin was observed from the third day after treatment, with a 50 percent reduction in symptoms within the first week of treatment and up to 94 percent reduction in the number of hyperhidrosis events after the second week. The reduction of symptoms lasted, on average, for 7 months. No cases of compensatory hyperhidrosis or mortality were observed. CONCLUSIONS: The treatment of primary hyperhidrosis with type A botulinum toxin, although temporary, is an effective, safe, and minimally invasive treatment option. It has a high degree of satisfaction and allows patients to return to their professional activities on the same day. Side effects and complications are temporary, infrequent, and regress without sequelae.

Estrangulação de intestino delgado devido a divertículo de Meckel e banda mesodiverticular em égua gestante – relato de caso / Strangulation of the small intestine by Meckel´s diverticulum and mesodiverticular band in a pregnant mare – Case Report

O objetivo deste trabalho é descrever a ocorrência de cólica por estrangulação intestinal ocasionada por banda mesodiverticular (BMD) e divertículo de Meckel (DM) em uma égua no terço final de gestação com histórico de 20 horas de cólica moderada contínua sem resposta à administração de analgésicos. Pela celiotomia constatou-se a presença de BMD e DM medindo 15cm a partir da borda anti-mesentérica, ocasionando estrangulação intestinal distante 150cm do orifício ileocecal. Realizaramse enterectomia de 290cm de alça necrosada, drenagem do conteúdo enegrecido e fétido do intestino remanescente, seguida de by pass do ceco por jejuno-colonostomia. Durante o pós-operatório, o quadro se manteve refratário à terapia intensiva instituída. O animal voltou a ter refluxo pela sonda nasogástrica e ocorreu abortamento após seis dias, sendo praticada a eutanásia após 24 horas. A BMD e o DM são estruturas remanescentes dos componentes onfalomesentéricos vitelinos, e sua ressecção deve ser considerada sempre que essas estruturas forem diagnosticadas durante a cirurgia abdominal em equinos. A égua deste relato viveu cinco anos sem consequências aparentes, até que tais alterações provocaram a estrangulação intestinal.

The objective of this report is to describe the occurrence of intestinal strangulation caused by mesodiverticular band (MDB) and Meckel´s diverticulum (MD) in a mare at the latter third of gestation with a 20 hours history of moderate colic unresponsive to analgesic medication. The celiotomy revealed the presence of 5.9 inches long MD and MDB causing intestinal strangulation 59 inches from the ileocecal valve. It was performed an enterectomy of 115 inches of necrotic loop, drainage of the dark and fetid content of the remaining intestine, followed by cecum bypass through jejunocolostomy. Despite the intensive therapy established during postoperative, the gastric reflux through the nasogastric tube came back, the mare suffered abortion after six days, and the euthanasia was performed after 24 hours. MDB and MD are remaining structures of vitelline omphalomesenteric components and their resection should be considered whenever these structures are diagnosed during abdominal surgery in equines. The mare on this report lived five years without apparent consequences; until the moment these alterations caused intestinal strangulation.

Tratamiento quirúrgico de la hiperhidrosis axilar: experiencia clínica y presentación de tres técnicas / Surgical treatment for axillary hyperhidrosis: three surgical techniques

La hiperhidrosis axilar es una condición muy invalidante para los pacientes que la padecen, ya que el estar permanentemente húmedos les provoca malestar, sensación de menoscabo y altera la vida de relación. La gran mayoría de los pacientes mejoran con los tratamientos tópicos, con iontoforesis o toxina botulínica, que, si bien son tratamientos paliativos, son capaces de terminar con las molestias.Sin embargo, existe un reducido grupo de pacientes que no responden a ningún tratamiento médico, presentando hiperhidrosis recalcitrante. Para ellos la opción quirúrgica es definitiva, ya sea mediante la simpatectomía dorsal alta, eliminando así la vía nerviosa eferente de la sudoración, que es una excelente opción para aquellos pacientes portadores de hiperhidrosis de axilas y manos; o a través de las técnicas para eliminar el órgano efector, las glándulas sudorales, en pacientes con hiperhidrosis limitada a las axilas.Se presentan tres técnicas quirúrgicas para eliminar la masa glandular: la técnica de Skoog con 4 colgajos, la liposucción y la técnica de Stenquist, que remueve la piel y sus glándulas.La serie es de nueve pacientes operados en 17 años; en siete de ellos se utilizó la técnica de Stenquist por ser la más sencilla, con menos complicaciones y excelentes resultados.

Axillary hyperhidrosis is a very distressing problem, excessive sweating and wet marks can be responsible for serious personal and social handicaps.The vast majority of patients improve with topical treatments using iontophoresis or with Botulinum toxin A, and although they are palliative therapies, they do put an end to the discomfort. However a small group of patients remains unresponsive to any medical treatment presenting a recalcitrant form of hyperhidrosis. For these patients, surgical option is a definitive solution, either by dorsal sympathectomy, eliminating the efferent pathway, ideal for axillary and palmar hyperhidrosis, or by extirpation of the effector organ, the sweat glands, in patients suffering only from axillary hyperhidrosis. Three surgical techniques are presented: Skoog’s technique with four-flaps, liposuction, and Stenquist’s technique that removes the skin and the subsidiary adipose tissue and glands.Nine patients surgically treated in a 17-year period constitute this clinical experience. Seven were operated with Stenquist’s technique, the most simple, with an excellent outcome.

Endoscopic lumbar sympathectomy for women: effect on compensatory sweat

INTRODUCTION: Plantar hyperhidrosis is present in 50 percent of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60 percent of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20 percent) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3 percent). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison) beyond that of the control group (p<0.05, inter-group comparison). Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05). These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal...

Simpatectomia torácica por videotoracoscopia para tratamento da hiperidrose primária: estudo retrospectivo de 521 casos comparando diferentes níveis de ablação / Video-assisted thoracic sympathectomy in the treatment of primary hyperhidrosis: a retrospective study of 521 cases comparing different levels of ablation

OBJETIVO: Comparar grau de satisfação dos pacientes simpatectomizados e presença de sudorese reflexa, de acordo com diferentes níveis de ablação. MÉTODOS: Estudo retrospectivo de 521 pacientes com hiperidrose primária, submetidos à simpatectomia torácica no Hospital Monte Sinai e Hospital Universitário da Universidade Federal de Juiz de Fora - UFJF, de janeiro de 2001 a dezembro de 2005. Grupo I (n = 162): termoablação do tronco simpático, tendo T2 como nível mais cranial da ressecção, independentemente de outros níveis seccionados caudalmente. Grupo II (n = 65): termoablação do tronco simpático, tendo T3 como nível mais alto. Grupo III (n = 294): termoablação do tronco simpático, tendo T4 como nível mais alto. RESULTADOS: Pós-operatório ótimo no controle da hiperidrose palmar/axilar em, respectivamente, 94/82 por cento dos pacientes do grupo I, 89/89 por cento do grupo II e 80/80 por cento do grupo III. Sudorese reflexa em 67 por cento dos pacientes dos grupos I e II, caindo para 61,29 por cento no grupo III devido à maior termoablação a partir de T4. Ocorreu sudorese reflexa severa em 32 por cento dos pacientes do grupo I, 9 por cento do grupo II e 4 por cento do grupo III. CONCLUSÃO: A simpatectomia propiciou excelente grau de satisfação e baixo índice de complicações. Não houve diferença na incidência de sudorese reflexa com diferentes níveis seccionados; porém, a intensidade desta complicação se mostrou menor quando optamos por níveis de bloqueio mais baixos, principalmente T4.

OBJECTIVE: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82 percent of the patients of group I, 89/89 percent of those in group II and 80/80 percent of those in group III. Postoperative reflex sweating was observed in 67 percent of the patients in groups I and II, compared with 61.29 percent of those in group III. Severe reflex sweating occurred in 32 percent of the group I patients, 9 percent of the group II patients and 4 percent of the group III patients. CONCLUSION: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.

Luteal phase of the menstrual cycle increases sweating rate during exercise

The present study evaluated whether the luteal phase elevation of body temperature would be offset during exercise by increased sweating, when women are normally hydrated. Eleven women performed 60 min of cycling exercise at 60 percent of their maximal work load at 32°C and 80 percent relative air humidity. Each subject participated in two identical experimental sessions: one during the follicular phase (between days 5 and 8) and the other during the luteal phase (between days 22 and 25). Women with serum progesterone >3 ng/mL, in the luteal phase were classified as group 1 (N = 4), whereas the others were classified as group 2 (N = 7). Post-exercise urine volume (213 ± 80 vs 309 ± 113 mL) and specific urine gravity (1.008 ± 0.003 vs 1.006 ± 0.002) changed (P < 0.05) during the luteal phase compared to the follicular phase in group 1. No menstrual cycle dependence was observed for these parameters in group 2. Sweat rate was higher (P < 0.05) in the luteal (3.10 ± 0.81 g m-2 min-1) than in the follicular phase (2.80 ± 0.64 g m-2 min-1) only in group 1. During exercise, no differences related to menstrual cycle phases were seen in rectal temperature, heart rate, rate of perceived exertion, mean skin temperature, and pre- and post-exercise body weight. Women exercising in a warm and humid environment with water intake seem to be able to adapt to the luteal phase increase of basal body temperature through reduced urinary volume and increased sweating rate.

Avaliação da perda hídrica durante treino intenso de rugby / Evaluation of water loss during high intensity rugby training

O rugby é um esporte no qual os jogadores passam a maior parte do tempo em atividades aeróbicas, mas há momentos em que se envolvem em atividades anaeróbicas. De acordo com a percentagem de desidratação corporal em relação ao peso, os sintomas fisiológicos podem variar desde sede até insuficiência renal e circulatória. O estudo teve como objetivo verificar a taxa de sudorese de atletas femininas de rugby. Para tanto, as atletas foram pesadas e submetidas a teste BIA antes e após o treino. O percentual de gordura corporal diminuiu em média 0,6 por cento e a redução em relação ao peso foi estatisticamente significativa de 1,5 por cento. As sensações fisiológicas de sede descritas pelas atletas condizem com o grau de desidratação encontrado. Este não apresenta riscos à saúde desta população, porém é necessário conscientizá-las quanto à importância de uma hidratação adequada para a melhora do desempenho físico.

Comparison of sweat rate during graded exercise and the local rate induced by pilocarpine

Centrally stimulated sweat rate produced by graded exercise until exhaustion was compared to the local sweat rate induced by pilocarpine, often used as a sweating index for healthy individuals. Nine young male volunteers (22 ± 4 years) were studied in temperate environment in two situations: at rest and during progressive exercise with 25 W increases every 2 min until exhaustion, on a cycle ergometer. In both situations, sweating was induced on the right forearm with 5 ml 0.5 percent pilocarpine hydrochloride applied by iontophoresis (1.5 mA, 5 min), with left forearm used as control. Local sweat rate was measured for 15 min at rest. During exercise, whole-body sweat rate was calculated from the body weight variation. Local sweat rate was measured from the time when heart rate reached 150 bpm until exhaustion and was collected using absorbent filter paper. Pharmacologically induced local sweat rate at rest (0.4 ± 0.2 mg cm-2 min-1) and mean exercise-induced whole-body sweat rate (0.4 ± 0.1 mg cm-2 min-1) were the same (P > 0.05) but were about five times smaller than local exercise-induced sweat rate (control = 2.1 ± 1.4; pilocarpine = 2.7 ± 1.2 mg cm-2 min-1), indicating different sudorific mechanisms. Both exercise-induced whole-body sweat rate (P < 0.05) and local sweat rate (P < 0.05) on control forearm correlated positively with pilocarpine-induced local sweat rate at rest. Assuming that exercise-induced sweating was a result of integrated physiological mechanisms, we suggest that local and whole-body sweat rate measured during graded exercise could be a better sweating index than pilocarpine.

Harlequin Syndrome with Crossed Sympathetic Deficit of the Face and Arm

Harlequin syndrome is characterized by unilateral hyperhidrosis and flushing, which are predominantly induced by heat or exercise. Usually, the sympathetic deficits confine to the face. Rarely, the autonomic deficits involve the arm or the parasympathetic neurons in the ciliary ganglia. We report a 43-yr-old woman who presented with facial flushing and sweating in the right side, which were mainly induced by exercise. The facial flushing accompanied relative coldness in the right arm. Valsalva maneuver, cold pressure and 0.125% pilocarpine test, and computed tomography of the chest were normal. The crossed sympathetic deficit in the left face and right arm suggested that the lesions were multifocal. The sympathetic impairment in our patient may lie on a spectrum of pre- and postganglionic autonomic dysfunction, which was observed in Holmes-Adie, Ross, and Guillain-Barre syndrome.

Hiperhidrosis: actualización / Update in hyperhidrosis

La hiperhidrosis se presenta en el 1 por ciento de la población general, en sus formas primaria o secundaria y sus distintas variantes clínicas. Se revisan los conceptos actuales en la fisiología y la bioquímica del olor sudoral, las formas clínicas de hiperhidrosis, las enfermedades asociadas y el tratamiento médico, tópico, iontoforesis, y en especial la terapia con toxina botulínica-A. Todas terapias paliativas y de efecto transitorio. En el tratamiento quirúrgico se resaltan los resultados definitivos y permanentes de las simpatectomías; y en axila, la extirpación local de olas glándulas sudorales que logra una espectacular mejoría con técnicas simples y seguras.

Influence of lateral posture on sweating: does posture alter the sympathetic outflow to the sweat glands?

Our unpublished observation that a lateral decubitus posture influences the pattern of sweating was systematically tested by measuring galvanic skin resistance (GSR). Changes in the GSR between two electrodes placed on skin was used to quantify the degree of sweating. In the lateral posture, sweating is inhibited on the lower half and stimulated on the upper half and reversal of the lateral posture induces sweating on the opposite half of the body. This observation suggests that the autonomic nervous system is controlled at least in part, by body posture.